Provider Demographics
NPI:1144921990
Name:HENSON, MATTHEW ADAM
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ADAM
Last Name:HENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 NE 4TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4301
Mailing Address - Country:US
Mailing Address - Phone:541-419-9488
Mailing Address - Fax:
Practice Address - Street 1:920 SW EMKAY DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1043
Practice Address - Country:US
Practice Address - Phone:541-388-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist